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      Right Testicular Artery Occlusion and Acute Appendicitis by Angiostrongylus costaricensis

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          Abstract

          Introduction. Angiostrongylus costaricensis is a nematode from the superfamily Metastrongyloidea, whose etymology is “roundworm that lives in blood vessels”. This parasite can be found from the southern United States to northern Argentina and southern Brazil. In 1983, Morera and Ruiz published the first case of a testicular artery occlusion by A. costaricensis. Case Presentation. A five year old boy presented with eight days of pain, denying trauma backgrounds and followed with an increase of volume. The treatment was a right simply orchiectomy, finding necrosis of the testicle, the biopsy showed reddish-purple aspect and soft consistency. Histologic studies reveled the presence of a worm inside the testicular artery. Conclusion. The diagnosis of A. costaricensis infection should be considered in all pediatric patients, with signs and symptoms of orchitis or acute abdomen, from endemic areas, may cause occlusion of the testicular artery and appendicular artery causing testicular and cecal appendix necrosis, respectively, even putting the patient's life at risk. The diagnosis is complex, because the clinical manifestations are similar to an orchitis or acute abdomen, therefore, the definitive diagnosis is made during the surgical intervention and histopathological study.

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          Most cited references23

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          Angiostrongylus costaricensis and the intermediate hosts: observations on elimination of L3 in the mucus and inoculation of L1 through the tegument of mollucs

          Human accidental infection with Angiostrongylus costaricensis may result in abdominal disease of varied severity. Slugs from the Veronicellidae family are the main intermediate hosts for this parasitic nematode of rodents. Phyllocaulis variegatus, Phyllocaulis soleiformis and Phyllocaulis boraceiensis were experimentally infected to describe the kinetics of L3 elimination in the mucus secretions of those veronicelid species. A maximum of 2 L3/g/day was found in the mucus, while the number of L3 isolated from the fibromuscular tissues varied from 14 to 448. Productive infection was established by inoculations in the hyponotum or in the body cavity, through the tegument. Intra-cavity injection is a less complex procedure and permits a better control of inocula. A preliminary trial to titrate the infective dosis for P. variegatus indicated that inocula should range between 1000 and 5000 L1. The data also confirmed the importance of P. variegatus as an intermediate host of A. costaricensis.
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            Histopathological criteria for the diagnosis of abdominal angiostrongyliasis

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              Diagnosis of abdominal angiostrongyliasis by PCR from sera of patients

              Abdominal angiostrongyliasis is a zoonotic infection caused by an intra-vascular nematode parasitic of wild rodents, Angiostrongylus costaricensis. No parasitological diagnosis is currently available and immunodiagnosis presents several drawbacks. Primers constructed based on a congeneric species, A. cantonensis, were able to amplify a 232 bp fragment from serum samples of 3 patients with histopathological diagnosis. Extraction was better performed with DNAzol and the specificity of the primers was confirmed by Southern blot. This disease has been diagnosed with frequency in south of Brazil, thus, this method appears like the important and unpublished alternative to improve diagnostic of disease.
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                Author and article information

                Contributors
                Journal
                Case Rep Surg
                Case Rep Surg
                CRIS
                Case Reports in Surgery
                Hindawi
                2090-6900
                2090-6919
                2019
                27 August 2019
                : 2019
                : 5670802
                Affiliations
                1Instituto Hondureño de Seguridad Social, Honduras
                2Pediatric Surgery Service, Hospital Escuela Universitario, Honduras
                3Hospital Escuela Universitario, Honduras
                4Universidad Nacional Autónoma de Honduras, Honduras
                Author notes

                Academic Editor: Tahsin Colak

                Author information
                https://orcid.org/0000-0002-5430-4136
                https://orcid.org/0000-0003-4669-4098
                Article
                10.1155/2019/5670802
                6732605
                31534812
                563363f5-43d3-4abc-af12-14877ef36d65
                Copyright © 2019 Luis Enrique Sánchez-Sierra et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 17 February 2019
                : 23 May 2019
                : 20 June 2019
                Categories
                Case Report

                Surgery
                Surgery

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